Start of the decline

I BeGAn work in 1989 at a local GP practice heralded as one of the best. there were six doctors with four fulltime and two job sharing.

the doctors made house calls and did paperwork between the morning and afternoon sessions. each doctor was on call one night a week, but would be back in the surgery at 9am the following day.

over time, the older GPs retired and were replaced by younger doctors determined to run the practice as a business.

they wanted to work office hours and have time to develop their careers so patients would benefit from their enhanced expertise. A night on call service was employed.

the GP contract introduced by Labour paid extra for the Well Woman clinics and diabetic monitoring the surgery was already doing.

Fundholding was welcomed by the doctors. they could buy services from organisations other than the local hospital. this meant patients could bypass lengthy waiting lists, but this depleted funds locally.

cost-cutting included the centralisation of district nurses and health visitors who had worked closely with the doctors.

tasks undertaken by doctors were passed on to nurses and patient services such as ear syringing, in-house physiotherapy and counselling were dropped.

When I started at the surgery, we had to answer the phone within three rings. now you can find yourself 14th

in the queue after having listened to a lengthy message about being nice to the staff. Name supplied, aylesbury, Bucks.